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What is already known about this subject There is an association between adiposity levels and physical activity guidelines for adolescents., Achieving physical activity recommendations helps adolescents to prevent obesity status., What this study adds This paper presents an association between physical activity levels and obesity status., This paper supports physical activity recommendations to avoid children's obesity levels., This paper emphasizes vigorous physical activity for this matter., Background There is no information about physical activity (PA) recommendations to avoid children's obesity levels and how much of vigorous PA (VPA) is included into the '60 minutes of MVPA 5 days a week' recommendation for children. Objective The aim of this study was to examine the association between PA and adiposity in children and to examine whether the current PA guidelines are associated with a low risk of having excess of body fat in children, with special focus on sex differences, and PA intensity. Methods A sample of 439 Spanish children aged 8-10 years from the European Youth Heart Study participated in the study. The variables measured were anthropometric characteristics (height, weight, body mass index [ BMI], skin-folds and waist circumference) and PA was measured during 6 consecutive days using the GT1M accelerometer. Results Receiver operating characteristic analysis showed significant cut-off points associated with non-overweight: 45 min d−1 of VPA and 67 min d−1 of moderate-to-vigorous physical activity ( MVPA) (using BMI categories); and non-fat: 41 min d−1 of VPA and 67 min d−1 of MVPA (using percentage of body fat) and 38 min d−1 of VPA and 47 min d−1 of MVPA (using waist circumference categories) for boys. For girls, the optimal cut-offs of moderate-to-vigorous activity and MVPA associated with non-overweight were 24 and 57 min d−1, respectively ( BMI). Boys who did not meet 67 min in MVPA had an increased risk of being overweight + obese and overfat + obese (odds ratio [ OR] = 2.48, 95% confidence interval [ CI] = 1.36, 4.53, and OR = 2.56, 95% CI = 1.12, 5.82). Conclusions The findings support current PA recommendations (60 min d−1 of MVPA) to avoid excess of body fat in Spanish children. However, VPA appears to be an important component for the prevention of obesity, and our findings suggest that PA recommendations should specify the dose of VPA required for optimal health. Therefore, public health PA recommendations should incorporate specifically a greater dose of VPA into the total amount of MVPA in 8- to 10-year-old boys. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to evaluate the psychological impact on nursing students at the end of period of confinement during the first wave of the COVID‐19 outbreak in Spain. Design: A cross‐sectional study reported in line with the STROBE guidelines. Methods: Nursing students were invited to complete an online questionnaire at the end of the 2019–2020 academic year using convenience sampling. The questionnaire collected data on sociodemographic factors, work, and life experiences in relation to COVID‐19, habits and lifestyle using the World Health Organization Five Well‐Being Index (WHO‐5) and the Generalized Anxiety disorder‐7 scale. Variables related to anxiety were analysed using multiple lineal regression analysis, Results: The prevalence of low psychological well‐being in the 203 students was 44.3% and of anxiety 55.7%. In the multivariate analysis the variables associated with anxiety were having worked in the pandemic, having had symptoms of COVID‐19 and having been afraid of getting infected. Conclusions: The levels of anxiety due to the COVID‐19 pandemic in nursing students have been high, and levels of psychological well‐being have been low. The fact of having worked during the pandemic, having had symptoms compatible with COVID‐19 or being afraid of getting infected are associated with the highest scores for anxiety. Relevance to clinical practice: This study gives more evidence on the psychological impact on nursing students during the first wave of the pandemic in Spain. This can be used to design anxiety management programmes for inclusion into teaching syllabuses. It also gives arguments for the setting up of psychological and emotional support services for these students and other healthcare professionals working during the pandemic. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) causes high rates of hospital admissions. It is known that disease progression impacts the health‐related quality of life (HRQoL) of both patients and caregivers, yet to date, this finding is based on cross‐sectional studies with limited samples. Objectives: The study aim is to analyze the relationship between HF patients' use of hospital services (a proxy for disease progression) and the HRQoL of their family caregivers. Methods: This work is a multicenter nested case‐control study on a population of patients admitted to hospitals in southern Spain due to heart failure. The sample comprised 530 patient‐caregiver dyads. Hospital admission data were retrospectively collected for the 5 years prior to inclusion in the study. Bivariate analyses and multivariate logistic regression were used to determine associations between patient deterioration and caregivers' quality of life. Results: Patients' use of hospital services was associated with worsened quality of life for family caregivers, with an overall OR of 1.48 (95% CI: 1.23‐1.79). A positive correlation was found between patients' perceptions of their physical health and the perceived mental health of caregivers (r = 0.127, p = 0.004) and between the perceived mental health of both (r = 0.291; p <0.0001). Conclusions: Greater use of hospital services by patients with HF is an independent predictor of deterioration of family caregivers' HRQoL. The physical and mental components of patients' and their family caregivers' HRQoL interact and influence each other. Additional factors, such as the nature and intensity of care provided, also determine the worsening of a family caregiver's HRQoL. Clinical Relevance: These results can be used to identify family caregivers of people with heart failure at risk of suffering a deterioration in their health‐related quality of life. Increased use of hospital services is an independent predictor of the deterioration of the family caregivers' health‐related quality of life. Since clinical nurses are the main provider who gives support and education to family caregivers, they should be alert to this situation and individualize interventions to prevent this deterioration. [ABSTRACT FROM AUTHOR]

Background/aim: Cocaine consumption may result in irreversible structural changes in the brain. The long‐term effects of cocaine are related to a wide range of deteriorated cognitive functions. This study aimed to examine the fine motor control and hand‐function in cocaine users compared to healthy controls. Methods: An observational study was conducted. Sociodemographic variables, substance consumption, the Purdue Pegboard and the Jebsen–Taylor Hand‐function Test were evaluated bilaterally in 35 participants who were cocaine users and in 35 healthy participants. Differences between sides (dominant and non‐dominant hands) and groups were analysed with analysis of variance (ANOVA). Results: The ANOVA revealed significant differences between groups (P < 0.001) and between sides (dominant and non‐dominant hands) (P = 0.005) for the one‐hand pin placement subtest of the Purdue Pegboard Test. Also, ANOVA tests showed significant differences between sides, but not groups, for the simulated feeding (P < 0.001) and stacking checkers (P < 0.001) Jebsen–Taylor subtests. Cocaine user participants exhibited significantly lower scores in bilateral pin placement and required more time for the Jebsen–Taylor subtests compared to healthy participants. Conclusions: Cocaine user participants display deficits of fine motor control and some aspects of manual dexterity when compared to healthy controls. These findings show the convenience of incorporating functional rehabilitation by occupational therapists as a key component within the treatment of cocaine users. This study therefore opens a new field of practice for occupational therapy based on the assessment and treatment of motor deficits in the hand and the upper limb of people who consume cocaine. [ABSTRACT FROM AUTHOR]

Prenatal methyl donor deficiency leads to homocysteine accumulation in the brain and impaired neurodevelopment in rats. We investigated the effect of moderately elevated preconception fasting total plasma homocysteine (tHcy) on child neurodevelopment in a prospective study of 67 and 76 mother-child pairs at 4 months and 6 years of age, respectively. Fasting blood samples at 2-10 weeks preconception, from the cord (nonfasting) and the mother and child 6 years after birth, were collected. Psychomotor and mental development were assessed at 4 months using the Bayley Scale of Infant Development (BSID) and cognitive development at 6 years using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI). Highest tertile preconception tHcy (≥9.04 µmol/L) was categorized as moderately elevated and low-mid tertile tHcy as normal. Children, born to mothers with moderately elevated compared to normal preconception tHcy, scored lower [mean (95% CI)] in the BSID psychomotor [115 (105, 124) vs. 126 (121, 130), p = 0.03] and mental [101 (93, 109) vs. 113 (107, 119), p = 0.03] development tests. Multiple logistic regression analysis showed that moderately elevated compared to normal preconception tHcy was associated with greater probability, OR (95%CI), of scoring in the lowest tertile for BSID psychomotor development (≤120): 4.0 (1.1, 14.3) and lowest tertiles for WPPSI full (≤111), verbal (≤104) and performance (≤111), intellectual quotient: 6.0 (1.5, 23.7), 3.5 (1.1, 11.2) and 4.1 (1.1, 15.7), respectively. We conclude that moderately elevated preconception tHcy is inversely associated with psychomotor and cognitive development scores in infants and children. [ABSTRACT FROM AUTHOR]

Objectives To compare the use of sonic powered or manual toothbrush in patients with intellectual disability ( ID) in terms of plaque (PlI) and gingival ( GI) indices and adverse effects. Material and Methods Subjects with ID were recruited for this cluster-randomized, single blinded (examiner), 6-month clinical trial, comparing powered versus manual toothbrushing. Outcome variables included PlI and GI, evaluated at baseline and 3 months after supervised toothbrushing and after 3 additional months of unsupervised used. Clinical outcome variables were analysed by repeated measures ANCOVA considering time and group as factors and respective baseline values as covariates (generalized linear model). Results Sixty-four patients (34 male, mean age 34.5) in six clusters were included in the study. No statistically significant effect of toothbrushing group was observed for PlI or GI. A significant effect of time was identified ( p < 0.001) with mean reductions ranging 0.44-0.45 for PlI and 0.30-0.36 for GI from baseline to 3-6 months. No relevant adverse effect or technical problems were observed. Conclusion The tested sonic powered toothbrush was as effective and safe as the manual toothbrush. The use of powered or manual toothbrushes, together with fluoride toothpaste, may improve plaque and gingivitis levels, in patients with mild to limit ID. [ABSTRACT FROM AUTHOR]

Background Protein-energy wasting ( PEW) is a highly prevalent condition in haemodialysis patients ( HD). The potential usefulness of nutritional-inflammatory markers in the diagnosis of PEW in chronic kidney disease has not been established completely. We hypothesised that a combination of serum albumin, percentage of mid-arm muscle circumference and standard body weight comprises a better discriminator than either single marker of nutritional status in HD patients. Methods A cross-sectional study was performed in 80 HD patients. Patients were categorised in two groups: well-nourished and PEW. Logistic regression analysis was applied to corroborate the reliability of the three markers of PEW with all the nutritional-inflammatory markers analysed. Results PEW was identified in 52.5% of HD patients. Compared with the well-nourished patients, PEW patients had lower body mass index, serum pre-albumin and body cell mass (all P < 0.001) and higher C-reactive protein (s- CRP) ( P < 0.01). Logistic regression analyses showed that the combination of the three criteria were significantly related with s- CRP >1 mg dL−1, phase angle <4°, and serum pre-albumin <30 mg dL−1 (all P < 0.05). Other indicators, such as lymphocytes <20% and Charlson comorbidity index, were significantly involved (both P < 0.01). A receiver operating characteristic curve ( area under the curve) of 0.86 ( P < 0.001) was found. Conclusions The combined utilisation of serum albumin, percentage of mid-arm muscle circumference and standard body weight as PEW markers appears to be useful for nutritional-inflammatory status assessment and adds predictive value to the traditional indicators. Larger studies are needed to achieve the reliability of these predictor combinations and their cut-off values in HD patients and other populations. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to assess the accuracy of periapical radiography in measuring peri-implant bone levels. Materials and Methods Twenty-five subjects with 46 implants in need of surgical treatment for peri-implantitis were included in this cross-sectional study. Prior to surgery, periapical radiographs were taken, a prediction of type of defect was made and radiographic peri-implant bone levels ( Rx BL) were determined at the mesial and distal aspects. Intra-operatively, the peri-implant bone level ( Surg BL) was assessed mesially, distally, buccally and orally and the type of defect was recorded. A paired t-test was applied to detect differences between inter-proximal Rx BL and Surg BL. ANOVA was used to compare Surg BL at different circumferential positions. Results The mean inter-proximal Rx BL was 4.0 ± 2.2 mm and the mean inter-proximal Surg BL was 5.3 ± 2.3 mm. The difference between Rx BL and Surg BL was statistically significant ( p = 0.014). There were no significant differences in Surg BL at the mesial, distal, buccal and oral aspects ( p > 0.05). Conclusions The intra-operatively measured peri-implant bone levels were more apical than the radiographic bone levels. The intra-operatively assessed peri-implant bone levels ( Surg BL) were similar at all the circumferential positions around the implant. [ABSTRACT FROM AUTHOR]

Aim. To explore the mechanisms by which some children select disruptive behaviours to cope with stressful dental events. In particular, the relationships between dental fear, expected effectiveness of destructive coping, and intentions of displaying uncooperative behaviours were analysed. Design. Participants were 170 children who filled out a questionnaire survey. Descriptive statistics by gender and group age as well as comparisons of means were calculated. Spearman's rho correlation coefficients and binary logistic regression analysis were used to test hypotheses of the relationships among variables. Results. Both dental fear and the expected effectiveness of destructive coping strategies were significantly associated with children's uncooperative intentions at the dentist. In addition, children who strongly endorsed the effectiveness of destructive coping strategies had a higher probability of uncooperative intentions as dental fear increased. In contrast, this relationship was not statistically significant among children who did not expect negative behaviours to be effective. Conclusions. Children's expectations about the effectiveness of destructive coping behaviours can help explain variations in the use of these strategies in stressful dental situations. Dental fear as well as children's inadequate expectancies about coping alternatives should be explored and targeted to prevent and modify uncooperative behaviour intentions at the dentist. [ABSTRACT FROM AUTHOR]

Background There are doubts on whether patients feel that they have sufficient information for actively participating in clinical decisions. Objective To describe the type of information that patients receive. To determine whether patients consider this information sufficient, and whether it contributes or not to improve clinical safety. To identify the barriers for patient participation in clinical decision making. Study Design Cross-sectional study with 764 patients and 327 physicians. Study Setting and participants Fourteen health centres belonging to three primary care districts and three hospitals in Spain. Principal Findings Just 35.1% (268) (95% CI 32.2, 39.1%) of patients preferred to have the last word in clinical decisions. Age (39 vs. 62%, P < 0.001) and severity of illness (38 vs. 46%, P = 0.002) increased the tendency to take a passive role. In 85.1% (650) (95% CI 83.3, 88.3%) of the cases, patients reported having received sufficient information. Lack of consultation time (29.6%, 95% CI 25.8, 32.5%) and patients' use of Internet or other sources (19.2%, 95% CI 16.4, 22.2%) were identified as new obstacles to doctor-patient communication by the patients. Only 19.6% (64) (95% CI 15.4, 24.2%) of doctors considered that they could intervene to involve patients in the decisions. Discussions and Conclusions The majority of patients prefer the decisions to be made by their doctor, especially those with more severe illnesses, and older patients. Patients are not normally informed about medication interactions, precautions and foreseeable complications. The information provided by general practitioners does not seem to contribute enough to the patient involvement in clinical safety. [ABSTRACT FROM AUTHOR]

A tool to assess the built environment, which takes into account issues of disability, accessibility and the need for data comparable across countries and populations, is much needed. The Collaborative Research on Ageing in Europe (COURAGE) in Europe Built Environment Outdoor Checklist (CBE-OUT) helps us to understand when features of the neighbourhood environment have either a positive or negative impact on the accessibility of neighbourhoods for healthy ageing. The CBE-OUT is composed of 128 items that can be recorded when present in the evaluated environment. Audits were performed in households randomly selected from each cluster of the sample for Finland, Poland and Spain, following precise rules defined by experts. Global scores were computed both section by section and in the overall checklist, rescaling the resulting scores from 0 (negative environment) to 100 (positive). The total number of completed CBE-OUT checklists was 2452 (Finland, 245; Poland, 972; and Spain, 1235). Mean global score for our sample is 49.3, suggesting an environment composed both of facilitating and hindering features. Significant differences were observed in the built environment features of the three countries and in particular between Finland and the other two. The assessment of features of built environment is crucial when thinking about ageing and enhanced participation. The COURAGE in Europe project developed this tool to collect information on built environment in an objective evaluation of environmental features and is a recommended methodology for future studies. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message The CBE-OUT checklist is an objective evaluation of the built environment and is centred on technical measurement of features present in the environment and has its foundations in the concepts of disability and accessibility operating in the International Classification of Functioning, Disability and Health (ICF) model., The CBE-OUT checklist can be analysed using both the total score and the single section score, allowing an evaluation of the facilitating or hindering role of the environment and is usable for predictive analysis of ageing trends., The CBE-OUT checklist makes it possible to collect information about the built environment by means of an objective evaluation of environment features and is a recommended methodology for future studies about the built environment. [ABSTRACT FROM AUTHOR]

Objectives The aim of the study was to assess the adequacy of initial antiretroviral therapy ( ART), in terms of its timing and the choice of regimens, according to the Spanish national treatment guidelines [ Spanish AIDS Study Group− National Plan for AIDS ( GeSIDA- PNS) Guidelines] for treatment-naïve HIV-infected patients. Methods A prospective cohort study of HIV-positive ART-naïve subjects attending 27 centres in Spain from 2004 to 2010 was carried out. Regimens were classified as recommended, alternative or nonrecommended according to the guidelines. Delayed start of treatment was defined as starting treatment later than 12 months after the patient had fulfilled the treatment criteria. Multivariate logistic and Cox regression analyses were performed. Results A total of 6225 ART-naïve patients were included in the study. Of 4516 patients who started treatment, 91.5% started with a recommended or alternative treatment. The use of a nonrecommended treatment was associated with a CD4 count > 500 cells/μL [odds ratio ( OR) 2.03; 95% confidence interval ( CI) 1.14-3.59], hepatitis B ( OR 2.23; 95% CI 1.50-3.33), treatment in a hospital with < 500 beds, and starting treatment in the years 2004-2006. Fourteen per cent of the patients had a delayed initiation of treatment. Delayed initiation of treatment was more likely in injecting drug users, patients with hepatitis C, patients with higher CD4 counts and during the years 2004-2006, and it was less likely in patients with viral loads > 5 log HIV-1 RNA copies/ml. The use of a nonrecommended regimen was significantly associated with mortality [hazard ratio ( HR) 1.61; 95% CI 1.03-2.52; P = 0.035] and lack of virological response. Conclusions Compliance with the recommendations of Spanish national guidelines was high with respect to the timing and choice of initial ART. The use of nonrecommended regimens was associated with a lack of virological response and higher mortality. [ABSTRACT FROM AUTHOR]

What is already known about this subject Eating disorders are among the public health issues facing adolescents., An excess of body fat has been associated with an increased risk of these disorders., The association of physical fitness with eating disorders has not yet been analysed in adolescents., What this study adds This study confirms that the overweight and obesity increase the risk of developing eating disorders., The present study shows that there is an inverse association between physical fitness levels and the risk of eating disorders., This study suggests that physical fitness might attenuate the influence of overweight on the development of eating disorders in adolescents., Background Eating disorders together with the overweight and obesity are important health concerns in adolescents. Objective To analyse the individual and combined influence of overweight and physical fitness on the risk of developing eating disorders in Spanish adolescents. Methods The sample consisted of 3571 adolescents (1864 females), aged 13 to 18.5 years, from Spain who participated in the AVENA and AFINOS studies. The risk of eating disorders was evaluated using the SCOFF questionnaire. Body mass index was calculated and the adolescents were classified into two groups: overweight (including obesity) and non-overweight according to Cole's cut-off points. Cardiorespiratory fitness in the AVENA Study was assessed by the 20-m shuttle-run test and the overall physical fitness level was self-reported in the AFINOS Study. Results Overweight adolescents had a higher risk of developing eating disorders than non-overweight adolescents (odds ratio [ OR] = 4.91, 95% confidence interval [ CI]: 3.63-6.61 in the AVENA Study and OR = 2.45, 95% CI: 1.83-3.22 in the AFINOS Study). Also, adolescents with medium and low levels of physical fitness had a higher risk of developing eating disorders ( OR = 1.51, 95% CI: 1.05-2.16, and OR = 2.25, 95% CI: 1.60-3.19, respectively, in the AVENA Study, and OR = 1.73, 95% CI: 1.37-2.17, and OR = 4.11 95% CI: 2.98-5.65, respectively, in the AFINOS Study) than adolescents with high levels of physical fitness. In both studies, the combined influence of overweight and physical fitness showed that adolescents with lower levels of physical fitness had an increased risk of developing eating disorders in both non-overweight and overweight groups. Conclusions Physical fitness might attenuate the influence of overweight on the development of eating disorders in adolescents. [ABSTRACT FROM AUTHOR]

Background The present study aimed to assess the association of obesity and malnutrition with the mortality of hospitalised patients with acute exacerbation of chronic obstructive pulmonary disease ( COPD) and the risk of readmission in <30 days. Methods A retrospective chart review of consecutive patients admitted with COPD as the primary reason for discharge in Spain between 1 January 2006 and 31 December 2007 was performed. Patients with a diagnosis of obesity or malnutrition in the hospital discharge clinical report were identified. The in-hospital mortality and re-admittance 30 days after discharge indices of obese and malnourished patients were compared against the subpopulation without these diagnoses. Results Of the 313 233 COPD admittances analysed, there were 22 582 (7.2%) diagnoses of obesity and 6354 (2.0%) diagnoses of malnutrition. In-hospital global mortality and the re-admittance risk were 12.0% and 16.7%, respectively. Obese patients showed a lower in-hospital mortality risk [odds ratio ( OR) = 0.52; 95% confidence interval (CI) = 0.49-0.55] and early re-admittance risk ( OR = 0.87; 95% CI = 0.85-0.92) compared to non-obese patients. Malnourished patients had a much higher risk of death when in hospital ( OR = 1.73; 95% CI = 1.62-1.85) or of being re-admitted within 30 days after discharge ( OR = 1.29; 95% CI = 1.22-1.38), even after adjusting for possible confounding factors. Conclusions Obesity in patients hospitalised for COPD substantially reduces in-hospital mortality risk and the possibility of early re-admittance. Malnutrition is associated with an important increase in in-hospital mortality and risk of re-admittance in the 30 days following discharge. [ABSTRACT FROM AUTHOR]

Objectives To examine epidemiological and clinical data of individuals aged 65 and older with influenza virus A ( H1 N1) admitted to the intensive care unit ( ICU) and to identify independent predictors of ICU mortality. Design Prospective, observational, multicenter study to determine prognostic factors in individuals infected with influenza A ( H1 N1) admitted to the ICU. Setting One hundred forty-eight Spanish ICUs. Participants Individuals with influenza A ( H1 N1) confirmed using real-time polymerase chain reaction from April 2009 to July 2011. Measurements Individuals aged 65 and older were compared with younger individuals. A multivariate analysis was conducted to determine independent predictors of mortality in this population. Results One thousand one hundred twenty individuals (129 (11.5%) aged ≥65) were included. Prevalence of chronic diseases was more common in older individuals. Viral pneumonitis was more frequent in individuals younger than 65 (70.5% vs 54.3%, P < .001). In older individuals, Acute Physiology and Chronic Health Evaluation II score (odds ratio ( OR) = 1.11, 95% confidence interval ( CI) = 1.11-1.20, P = .002), immunosuppression ( OR = 3.66, 95% CI, 1.33-10.03, P = .01) and oseltamivir therapy initiated after 48 hours ( OR = 3.32, 95% CI = 1.02-10.8, P = .04) were identified as independent variables associated with mortality. Corticosteroid use was associated with a trend toward greater mortality ( OR = 2.39, 95% CI = 0.98-5.91, P = .06). Conclusion Individuals aged 65 and older with influenza A ( H1 N1) admitted to the ICU have a higher incidence of underlying diseases than younger individuals and differences in clinical presentation. Early oseltamivir therapy is associated with better outcomes in elderly adults. [ABSTRACT FROM AUTHOR]

Objectives To evaluate whether the Enhanced Feedback for Effective Cardiac Treatment ( EFFECT) scale for 30-day prediction of mortality is applicable to elderly adults with acute heart failure ( AHF) in emergency departments ( EDs) and whether discriminatory power is added with the inclusion of the Barthel Index ( BI) to this scale ( BI- EFFECT scale). Design BI-EFFECT is a multipurpose, nonintervention, multicenter cohort study. Setting Twenty EDs. Participants Individuals aged 65 and older with AHF. Measurements Information on baseline and episode characteristics and 30-day mortality was collected, and participants were categorized according to the EFFECT scale. Baseline degree of functional dependence was measured using the BI. Receiver operating characteristic ( ROC) curves were made of the EFFECT and BI- EFFECT scales to predict mortality. Results One thousand sixty-eight participants were included. Thirty-day mortality was 5.1% and was directly and independently associated with high and very high risk categories of the EFFECT scale and with severe dependence. These two variables remained significant after adjustment of the model for both ( OR = 4.5, 95% CI = 1.8-11.1 and OR = 2.9, 95% CI = 1.6-5.4, respectively). The EFFECT and the BI- EFFECT scales had significant ROC curves (area under the ROC curve ( AUC) = 0.69, 95% CI = from 0.62 to 0.76; and AUC = 0.75, 95% CI = 0.69-0.81, respectively), and the difference in discriminatory power between the second and the first was also statistically significant ( P = .02). Conclusion The EFFECT scale may be applied in the elderly population, and inclusion of functional status according to the BI in the new BI- EFFECT scale significantly improves the model for the prediction of 30-day mortality. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which is concerned with functional recovery in older hospitalized adults.

Objective To assess the relationship between childhood sexual and physical abuse, and key attitudinal and behavioural aspects of eating disorders (ED). Method Participants included 708 female undergraduates in a Spanish public university, aged from 18 to 30. Abuse was measured by the Traumatic Life Events Questionnaire, and ED by the Eating Disorders Examination Questionnaire (EDE-Q). Results 14.3% of the sample had suffered childhood sexual abuse (CSA) and 3.8% childhood physical abuse (CPA). With respect to ED attitudinal features, we observed an increased Weight Concern score among CSA survivors. No association was found between this kind of abuse and disordered eating behaviours, after adjusting for depression, anxiety, self-esteem, body mass index, age and socioeconomic status. An inverse relationship was found between CPA and ED attitudes measured by EDE-Q (Restraint, Weight Concern, Shape Concern and the Overall Score), whereas no association was found with the behavioural aspects of eating disturbances. Discussion After controlling for different risk factors, CSA appears to be related to an increased Weight Concern, whilst other ED attitudinal features and behaviours do not seem to be related to childhood abuse. The inverse relationship found is discussed. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]